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Circ Arrhythm Electrophysiol. 2015 Dec;8(6):1359-65. doi: 10.1161/CIRCEP.115.002966. Epub 2015 Nov 2.

On the Quest for the Best Freeze: Predictors of Late Pulmonary Vein Reconnections After Second-Generation Cryoballoon Ablation.

Author information

1
From the Heart Rhythm Management Centre, UZ Brussel-VUB, Brussels, Belgium. g.ciconte@gmail.com.
2
From the Heart Rhythm Management Centre, UZ Brussel-VUB, Brussels, Belgium.

Abstract

BACKGROUND:

The second-generation cryoballoon is effective in achieving acute pulmonary vein isolation (PVI) and favorable clinical outcome. To date, no data are available on factors affecting late PV reconnection after second-generation cryoballoon ablation.

METHODS AND RESULTS:

A total of 29 consecutive patients (25 male, 86.2%; mean age 57.8±13.8 years) underwent a repeat procedure, after a mean 11.6±4.5 months (range, 3.5-19.7 months), after index ablation using the 28-mm second-generation cryoballoon. All repeat ablations were performed using a 3-dimensional electroanatomical mapping system. Among all 115 PVs, including 1 left common ostiums (LCOs), 25 (21.7%) showed a PV reconnection in 20 patients (1.25 per patient). Persistent PVI could be documented in 90 of 115 PVs (78.2%). In 9 of 29 patients (31%), all PVs were electrically isolated. In the multivariable analysis, time to PVI (P=0.03) and failure to achieve -40°C within 60 s (P=0.05) independently predicted late PV reconnection. At receiver-operator curve analysis, time to PVI <60 s identified the absence of PV reconduction (sensitivity, 86.7%; specificity, 86.2%; positive predictive value, 59.1%; and negative predictive value, 96.4%; area under the curve, 0.85; confidence interval, 0.73-0.97; P<0.001).

CONCLUSIONS:

The rate of late PV reconnection after second-generation cryoballoon ablation is low (1.25 PVs/patient). Faster time to isolation and achievement of -40°C within 60 s independently predict durable PVI. In addition, 60-s cut-off for time to PVI indicates persistent isolation with 96.4% negative predictive value. These parameters might guide the operator whether to perform further applications to ensure a long-lasting PVI.

KEYWORDS:

atrial fibrillation; cryoballoon ablation; pulmonary vein isolation; pulmonary vein reconnection; second-generation cryoballoon

PMID:
26527624
DOI:
10.1161/CIRCEP.115.002966
[Indexed for MEDLINE]

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